Surgical vs Conservative Treatment of Displaced Intra-articular Calcaneal Fractures: A Prospective RCT

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Agren, Per-Henrik, M.D.
ClinicalTrials.gov Identifier:
NCT01615744
First received: June 5, 2012
Last updated: June 7, 2012
Last verified: June 2012
  Purpose

Between 1994-98 5 hospitals in Stockholm investigated calcaneal fractures in a randomised study.

82 patients were included and randomized either to non-surgical treatment or surgical management with extensile lateral approach and reduction with Internal fixation (ORIF) The patients were followed and investigated at fixed intervals 2 weeks, 8 weeks, 3 months and 6 months for clinical review. At 1 year and 8-12 years (mean 10 years) post-injury.

Both clinical radiological data were collected and several scores were used. The primary outcomes scores used were SF-36 and VAS score.

The results after 1 year and mean 10 years are presented.


Condition Intervention
Os Calcis Fracture
Procedure: Open Reduction Internal Fixation
Procedure: Non-surgical management

Study Type: Observational
Study Design: Observational Model: Case Control
Time Perspective: Prospective
Official Title: Surgical vs. Conservative Treatment of Displaced Intra-articular Calcaneal Fractures: A Prospective, Randomized, Controlled Multicenter Trial

Resource links provided by NLM:


Further study details as provided by Agren, Per-Henrik, M.D.:

Primary Outcome Measures:
  • SF-36 [ Time Frame: 1 year and 10 years post injury ] [ Designated as safety issue: No ]
    The investigators anticipate that there might be a change over time and want to investigate and describe it

  • VAS-score (calcaneal fractures) /Hildebrand, Buckley [ Time Frame: 1 year and 10 years post injury ] [ Designated as safety issue: No ]
    The investigators anticipate that there might be a change over time and want to investigate and describe it


Secondary Outcome Measures:
  • VAS of pain at rest and exertion [ Time Frame: 2 weeks,6 weeks,12 weeks,1 year, 3 years and 10 years post injury ] [ Designated as safety issue: No ]
    The investigators anticipate that there might be a change over time and want to investigate and describe it

  • AOFAS hindfoot scale [ Time Frame: 1 year and 10 years post injury ] [ Designated as safety issue: No ]
    The investigators anticipate that there might be a change over time and want to investigate and describe it

  • Olerud-Molander score [ Time Frame: 1 year and 10 years post injury ] [ Designated as safety issue: No ]
    The investigators anticipate that there might be a change over time and want to investigate and describe it


Enrollment: 82
Study Start Date: December 1993
Study Completion Date: December 1998
Primary Completion Date: January 1994 (Final data collection date for primary outcome measure)
Groups/Cohorts Assigned Interventions
Surgical ORIF calcaneal fx Procedure: Open Reduction Internal Fixation
Lateral approach through extensile lateral incision ( Benirschke), Reduction ( Soeur et Remy) and internal fixation with lateral plating with or without bone graft
Other Name: Surgery
Conservative treatment calcaneal fx Procedure: Non-surgical management
Early active exercises and elevation to decrease swelling
Other Names:
  • No surgery
  • early movement
  • decreasing swelling

  Hide Detailed Description

Detailed Description:

The study was approved by the local ethical committee. Seven trauma orthopaedic surgeons in five hospitals in Stockholm were recruited in this RCT, which was conducted between 1994 and 1998. Patients presented with > 2mm DIACFs verified by axial and coronal computerized tomography (CT) scan were considered for inclusion. Exclusion criteria included peripheral neuro-vascular disease (signs and symptoms of ischemia or neuropathy), open fractures, uncontrolled diabetes mellitus and medical contra-indications to surgery.

All centers used the same study protocol. Demographic data were obtained from the patients, as they deemed eligible to participate in the study. Informed consent was obtained from each patient. Randomization was carried out by sealed opaque envelope to choose surgical vs. conservative treatment.

The surgical treatment was carried out within 2 weeks post-injury when the local soft tissue swelling subsided. Surgery included open reduction using the lateral extensile approach according to Benirschke (ref) and manipulation of the fragments as described by Soeur and Remy (ref) to achieve anatomical reduction, which then was fixed by screws, reconstruction plates or calcaneal plates. Using bone grafts was left to the judgment of the surgeon. Postoperatively, plain X-ray and CT scan were used to evaluate the quality of fracture reduction. Sex week's non-weight bearing was advocated for all patients. Range-of-motion exercises were allowed during this period. Thereafter, the patients had a standardized physiotherapy regimen with full weight bearing.

The conservative treatment included rest, elevation and non-weight bearing. Early range-of-motion exercises were encouraged as tolerated. After 6-8 weeks weight bearing was allowed and shoe modification was provided to those who had hind foot deformities.

No patients were managed with impulse compression therapy.

Patients of both groups were followed-up by treating surgeons at 2 weeks, 8 weeks, 3 months and 6 months for clinical review. At 1 year and 8-12 years (mean 10 years) post-injury, all patients were evaluated by unbiased surgeons who were not involved in the treatment of the patients and they completed the following questionnaires:

  1. Primary outcome measures: visual analogue scale (VAS) scoring devised and tested by Hildebrand et al (ref) and a self-administrated general health outcome form (SF-36) for physical and mental health.
  2. Secondary outcome measures: VAS at rest and on weight bearing (0-10), the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot scale and the Olerud-Molander (OM) score.

The investigators divided each group into two subgroups, younger and older than 50 years to determine if the results of the outcome measures at 1 year would differ according to the age of the patients.

During controls, clinical evaluation was carried out to measure the ankle joint and subtalar joint range of motion and the length and width of the hind foot. The contra-lateral non-fractured foot was used for comparison. Shoe problems, the outcome of any eventual postoperative/post-injury complications and workers´ compensation were documented. Radiological follow-up with axial and coronal CT scan was done at the 1 year and 3 years visits.

Statistical analysis The SPSS program version 18.0 for personal computers (Chicago, Illinois) was used for data analysis. The variables of interests were analyzed to determine the differences using bivariate comparisons. The means with standard deviation (SD) were measured. The Mann-Whitney test was used for non-parametric data while two-sample t-test was used for parametric data. A p value of <0.05 was considered significant.

  Eligibility

Ages Eligible for Study:   18 Years to 78 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Sampling Method:   Probability Sample
Study Population

Between 1994 and 1998. Patients presenting at 5 hospitals in Stockholm after trauma resulting in a fracture with > 2mm Dislocated Intraarticular Calcaneal Fractures (DIACFs) verified by axial and coronal computerized tomography (CT) scan were considered for inclusion

Criteria

Inclusion Criteria:

  • Patients presented with > 2mm DIACFs verified by axial and coronal computerized tomography (CT) scan were considered for inclusion

Exclusion Criteria:

  • Peripheral neuro-vascular disease (signs and symptoms of ischemia or neuropathy), open fractures, uncontrolled diabetes mellitus and medical contra-indications to surgery.
  Contacts and Locations
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Please refer to this study by its ClinicalTrials.gov identifier: NCT01615744

Locations
Sweden
Stockholms Fotkirurgklinik, Sophiahemmet
Stockholm, Sweden, 11486
Sponsors and Collaborators
Agren, Per-Henrik, M.D.
Investigators
Principal Investigator: Per-Henrik Aagren, MD Consultant Orthopaedic Surgeon
  More Information

No publications provided

Responsible Party: Agren, Per-Henrik, M.D.
ClinicalTrials.gov Identifier: NCT01615744     History of Changes
Other Study ID Numbers: CalcanealfxRCT
Study First Received: June 5, 2012
Last Updated: June 7, 2012
Health Authority: Sweden: Regional Ethical Review Board
Sweden: The National Board of Health and Welfare

Keywords provided by Agren, Per-Henrik, M.D.:
calcaneal fractures
surgical treatment
conservative treatment
VAS scoring
SF-36
AOFAS
Olerud-Molander score
outcome

Additional relevant MeSH terms:
Fractures, Bone
Wounds and Injuries

ClinicalTrials.gov processed this record on August 19, 2014